Epstein-Barr Virus

Question 1

What is the family?

Answer 1

Herpesvirus

Question 2

Where does it replicate in? What does this cause?

Answer 2

Replicates in B lymphocytes and epithelial cells in oropharyngeal secretions, causing polyclonal growth stimulation and lymphoid hyperplasia

Question 3

What does it cause in normal lymphocytes?

Answer 3

Immortalisation (continuously dividing cell line)
Expression of nuclear neoantigens (EB nuclear antigen)

Question 4

What are the clinical features?

Answer 4

1. Infectious mononucleosis
2. Burkitt’s lymphoma
3. Nasopharyngeal carcinoma
4. Immunoblastic lymphoma
5. Chronic fatigue syndrome

Question 5

What are the clinical presentations of infectious mononucleosis?

Answer 5

• Glandular fever
• Lethargy
• Anorexia
• Pharyngitis
• Hepatosplenomegaly
• Lymphadenopathy
• Exudative tonsillitis
• Rash exacerbated by ampicillin

Question 6

How long is the incubation period of infectious mononucleosis?

Answer 6

4 - 7 weeks

Question 7

How is EBV transmitted?

Answer 7

Close-contact - “kissing disease”

Question 8

Who is EBV most prevalent in?

Answer 8

Seronegative children and young adults

Question 9

What are the complications of infectious mononucleosis?

Answer 9

1. Hepatitis (may have jaundice, abnormal LFT)
2. Pneumonitis
3. Neurological (aseptic meningitis, encephalitis, myelitis, optic neuritis, acute cerebellar ataxia, Guillain-Barré syndrome, peripheral neuropathy, Bell’s palsy)
4. Haematological (haemolytic anaemia, thrombocytopaenia, splenic rupture)
5. Myocarditis, pericarditis

Question 10

What do Burkitt’s Lymphoma cells express? Which chromosomal translocation is involved? Which areas does it occur?

Answer 10

• EBV markers (e.g. EBNA)
• 8;14 or 2;22 (deregulation of c-myc oncogene)
• Occurs in. holoendemic malaria in tropical Africa

Question 11

Who is at risk for immunoblastic lymphoma?

Answer 11

Lymphoproliferative disorder in patients with impaired cell-mediated immunity (AIDS, iatragenically induced in organ transplant recipients)

Question 12

How does chronic fatigue syndrome present?

Answer 12

Extreme fatigue, fever, sore throat, painful lymphadenopathy, muscle weakness, memory loss

Question 13

How to diagnose?

Answer 13

1. Atypical lymphocytosis and mononuclear cells (at least 10%)
2. Paul-Bunnell Test - Heterophile antibodies (present in 90%)
   - monospot screening test
   - haemagglutinating Ab to sheep RBCs -> Ab removed by adsorption with ox RBC but not with guinea pig kidney
3. 90% of healthy adults have EBV Ab so EBV IgM useful confirmation for IM
   - viral capsid antigen Ab
   - EB nuclear antigen Ab
   - early antigen Ab

Question 14

How to treat?

Answer 14

Treat the symptoms
Avoid penicillin

Question 15

Is there EBV vaccine?

Answer 15

Undergoing clinical trials